Background: Hospital medicine – orthopedic surgery co-management programs can improve postoperative outcomes and efficiency. Rising surgical volume at Stanford Health Care Tri-Valley, a community academic hospital affiliated with Stanford University, created a need for a structured approach to managing complex joint arthroplasty patients. To meet this demand and optimize resource use, the hospital medicine and [...]

Background: Prolonged hospital length of stay (LOS) and extended observation time negatively affect patient flow, resource utilization, and emergency department (ED) efficiency. Observation patients held in the ED often face delays in diagnostic testing, inconsistent care processes, and limited bed availability, contributing to system-wide congestion and increased healthcare costs. To address persistent ED overcrowding and [...]

Background: Emergency department (ED) boarding time is an important measure of throughput and is also known to impact patient safety and experience. Hospitalized patients often have complex medical issues involving different specialties, and timely assignment of admission service is critical to reduce ED boarding. Many hospitals lack consistent guidelines for assigning patients to the most [...]

Background: Effective capacity management of hospitalized patients remains a challenge within many medical institutions. Inpatient flow efficiency is an increasingly critical component of hospital operations, as an increased prevalence of chronic diseases manifests, the aging population continually grows, and we subsequently see a rise in higher acuity disease states that warrant inpatient level of care. [...]

Background: Environmental services (EVS) staff play a critical role in maintaining a safe, clean, and healthy hospital environment by performing timely cleaning, disinfecting, and waste management. In a Comprehensive Cancer Center comprised of approximately 764 active, current inpatient beds, a well-trained EVS team supports clinical care by ensuring rooms are cleaned and disinfected to reduce [...]

Background: Overnight sleep disruptions in hospitalized patients is a well-known contributor to increased delirium risk and decreased patient satisfaction. Despite decades of work to reduce such disruptions, they persist. Medication dosing is a common type of disruption. Behavioral economics suggest defaults offer a powerful nudge to change outcomes. There is no evidence that default dosing [...]

Background: Effective onboarding is essential for physician confidence, safety, efficiency, and early integration into a hospital medicine division. Onboarding into a large academic institution adds additional complexities including medical trainee oversight, elaborate shift structure and responsibilities, and multiple practice sites. Despite existing orientation materials, new hires at our Academic Institution reported variable preparedness for their [...]

Background: The clinical indication for vascular access devices (VAD), including central venous catheters (CVC) and peripheral intravenous catheters (PVC), should be assessed at least daily. If VADs are no longer indicated, they should be promptly removed to reduce the risk of catheter-associated bloodstream infections (CABSI). In 2030, the CDC’s National Healthcare Safety Network (NHSN) will [...]

Background: Medication reconciliation (MR) is essential for safe and high-quality patient care, particularly with setting changes at admission and discharge.1 Prior studies have reported MR errors in up to 67% of patients at admission, with nearly 60% of these deemed clinically significant.2 Purpose: We aimed to innovate both the measurement and completion of resident-led MR [...]

Background: Hospitalists fulfill a wide range of clinical responsibilities including off-hour cross-coverage that often requires extensive direct patient care. Although accurate documentation of physician services—such as cognitive work, technical skills, and time—forms the foundation for generating relative value units (RVUs), inconsistent documentation practices within our hospitalist group have hindered the appropriate recognition of this high-value [...]